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In Brief: what happens during the initial consultation?

In: Latest News, Series: "What happens in a session of psychotherapy?"

People who come to see me for the first time often tell me: “I’ve never done this, what happens now?”. The workings of psychotherapy appear indeed to be shrouded in mystery, which is why I’d like to list a few useful bearings for people who are considering psychotherapy or counselling and haven’t carried out extensive research. I have taken those from a longer article from this blog, which you can find by following this link.

The goal of the initial consultation is to find out if therapist and patient can work together, and if so, how. To do this, I pay attention to what a person tells me, and how they say it to me. At the end of the consultation, I am able to tell the person if psychotherapy could be of benefit to them, and will discuss frequency, term and boundaries.

The “what?”

There are a few direct, specific questions that I like to ask to find out more about the person’s history and current circumstances.

For example, I may ask someone suffering from symptoms of anxiety to describe how they experience them, and what impact they have on their life and their daily functioning. I’ll also be curious about the history of these symptoms: are they a new experience, are they reoccurring? Also, do they seem to be triggered by external factors (such as, for example, an deadline approaching for a performance, being in the same room as a specific person, or being in crowded places) or do they seem to be occurring spontaneously?

I also consider all facts about a person’s earlier life to be a very important source of insight for both patient and therapist, for two reasons: first, it tells me what external factors may have influenced their development during childhood; second, it tells me how the person understands themselves. When I know more about what a person’s life has been like, and how they have this in mind, I have useful, factual information that allow me to decide whether or not it is appropriate to offer to help them through psychotherapy.

The “how?”

Not all of us will have paused and thought about ourselves as a person with a past, present and future. To many people that I have worked with, this even initially looked like “a luxury”. Life indeed seems to afford few opportunities to stop and truly reflect on oneself. And we are often given the message by our parents, friends, colleagues, partners and bosses to “get on with it” and not indulge in “navel-gazing”…

This is why it is not rare that people aren’t really able to tell me much about themselves, even when I ask them specific and precise questions. This is why I pay as much attention to what people tell me to he way they tell me it. And if I find that, in an initial consultation, a person find it difficult to tell me about themselves using words, I will help them to concentrate on this very difficulty, so that they may begin to see themselves more clearly and progress towards a better comprehension and verbalisation of their experience.

I have written an account of such a consultation in a longer version of this article, which you can read here.

What happens at the end of the session?

Before the fifty minutes of the consultation are up, I will tell the person if I can offer to see them for psychotherapy. If they tell me that they would like to start therapy, we then discuss the frequency of the sessions, and whether they want to set a term to their treatment from the outset. Some people also want to set specific goals, which we can discuss, and some will prefer to have free rein to get into whichever area of their life they feel is important in every individual session.

In my experience, my patients benefit most from therapy when they are able to come at least once a week, and the large majority of people choose not to set a term for their engagement in therapy right at the beginning. Some choose to do this later on.

Once I have communicated my policy that I require seven days’ notice for any change of session, the patient and I decide whether or not we will see each other again, and if yes, we make an appointment for the following time. Many people choose to start treatment right away and will set their appointment time and frequency there and then.

By: Cedric
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